[Insufficiency fracture of the pelvis after the radiotherapy for carcinoma of the uterine cervix].
Bone injury after the radiotherapy for carcinoma of the uterine cervix has been reported since early days of this century. Recently, the concept of insufficiency fracture has been confirmed. Insufficiency fracture is one of the stress fractures and occurs when the elastic resistance of bone is inadequate to withstand normal or physiological stress. In the American and European studies, radiotherapy is known as a cause of insufficiency fracture. There are no reports on insufficiency fracture in the Japanese literatures. Four cases of carcinomas of the uterine cervix presented pelvic insufficiency fractures following radiotherapy. In the public bone, a vertical para-symphyseal fracture with mixed lytic and sclerotic changes of surrounding tissue is characteristic. Sacral insufficiency fracture shows a vertical or horizontal line with lytic and sclerotic appearance. Bone scintigraphy is a sensitive modality for the early detection. H-shaped configuration is diagnostic for sacral insufficiency fracture. CT is an accurate technique demonstrating a vertical fracture and excluding the malignant bony lesion. Although radiological findings of insufficiency fracture are similar to bone malignancy, differential diagnosis from malignant lesions is possible. Bony symptoms of all patients disappeared without specific treatments. In the follow-up study of patients with carcinomas of the uterine cervix after radiotherapy, it is important to have the consideration on insufficiency fracture.
Nishimura
T
T
Department of Radiology, Hamamatsu University School of Medicine.
Shimizu
T
T
Sugiyama
A
A
Ichinohe
K
K
Teshima
T
T
Takahashi
M
M
Takai
M
M
Kaneko
M
M
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000532:radiotherapy*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D011877:Radionuclide Imaging; D011878:Radiotherapy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000532:radiotherapy*